[The ureteric risk in laparoscopic surgery].

Objective: To describe the circumstances of development, diagnostic approach and treatment of iatrogenic ureteric lesions after laparoscopic surgery.
Material and Methods: From 1992 to 2003, nine patients with iatrogenic trauma of the ureter after laparoscopic surgery were managed by our team.
Results: The time to diagnosis ranged from 0 to 640 days. These injuries were related to gynaecological surgery in 56% of cases, gastrointestinal surgery in 22% of cases, vascular surgery in 11% of cases, and spinal surgery in 11% of cases. The two lesions identified intraoperatively were treated immediately with success. In the case of lesions identified secondarily, first-line endourological treatment was performed in 57% of cases with a good result without reoperation in only 25% of cases. Three patients required reoperation with 66% of satisfactory results and two patients were treated by nephrectomy.
Conclusion: Intraoperative difficulties and limited experience of laparoscopic surgery are the factors most frequently identified in iatrogenic ureteric lesions. The time to diagnosis has a considerable impact on the modalities and results of management.